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INFORMED CONSENT AND WAIVER OF LIABILITY IN A
FITNESS TRAINING PROGRAM

1. PURPOSES AND EXPLANATION OF PROCEDURE
I hereby consent to voluntarily engage in an acceptable plan of
personal fitness training. I also give consent to be placed in
personal fitness training program activities which are
recommended to me for improvement of dietary counseling, stress
management, and health/fitness education activities. The levels of
exercise I perform will be based upon my cardiorespiratory (heart
and lungs) and muscular fitness. I understand that I may be
required to undergo a graded exercise test prior to the start of my
personal fitness training program in order to evaluate and assess
my present level of fitness.
I will be given exact personal instructions regarding the amount
and kind of exercise I should do. A professionally trained personal
fitness trainer will provide leadership to direct my activities,
monitor my performance, and otherwise evaluate my effort.
Depending upon my health status, I may or may not be required to
have my blood pressure and heart rate evaluated during these
sessions to regulate my exercise within desired limits. I understand
that I am expected to attend every session and to follow staff
instructions with regard to exercise, stress management, and other
health and fitness regarded programs. If I am taking prescribed
medications, I have already so informed the program staff and
further agree to so inform them promptly of any changes which my
doctor or I have made with regard to use of these. I will be given
the opportunity for periodic assessment and evaluation at regular
intervals after the start of the program.
I have been informed that during my participation in the above
described personal fitness training program, I will be asked to
complete the physical activities unless symptoms such as fatigue,
shortness of breath, chest discomfort or similar occurrences appear.
At this point, I have been advised that it is my complete right to
decrease or stop exercise and that it is my obligation to inform the
personal fitness training program personnel of my symptoms,
should any develop.
I understand that during the performance of exercise, a personal
fitness trainer will periodically monitor my performance and,
perhaps measuring my pulse, blood pressure, or assess my feelings
of effort for the purposes of monitoring my progress. I also
understand that the personal fitness trainer may reduce or stop my
exercise program when any of these findings so indicate that this
should be done for my safety and benefit.
I also understand that during the performance of my personal
fitness training program physical touching and positioning of my
body may be necessary to assess my muscular and bodily reactions
to specific exercises, as well as to ensure that I am using proper
technique and body alignment. I expressly consent to the physical
contact for the stated reasons above.

2. RISKS
It is my understanding and I have been informed that there exists
the remote possibility during exercise of adverse changes
including, but not limited to, abnormal blood pressure, fainting,
dizziness, disorders of heart rhythm, and in very rare instances
heart attack, stroke, or even death. I further understand and I have
been informed that there exists the risk of bodily injury including,
but not limited to, injuries to the muscles, ligaments, tendons, and
joints of the body. Every effort, I have been told, will be made to
minimize these occurrences by proper staff assessments of my
condition before each personal fitness training session, staff
supervision during exercise and by my own careful control of
exercise efforts. I fully understand the risks associated with
exercise, including the risk of bodily injury, heart attack, stroke or
even death, but knowing these risks, it is my desire to participate as
herein indicated.

3. BENEFITS TO BE EXPECTED AND ALTERNATIVES
AVAILABLE TO EXERCISE
I understand that this program may or may not benefit my physical
fitness or general health. I recognize that involvement in the
personal fitness training sessions will allow me to learn proper
ways to perform conditioning exercises, use fitness equipment and
regulate physical effort. These experiences should benefit me by
indicating how my physical limitations may affect my ability to
perform various physical activities. I further understand that if I
closely follow the program instructions, that I will likely improve
my exercise capacity and fitness level after a period of 3-6 months.

4. CONFIDENTIALITY AND USE OF INFORMATION
I have been informed that the information which is obtained in this
personal fitness training program will be treated as privileged and
confidential and will consequently not be released or revealed to
any person, to the use of any information which is not personally
identifiable with me for research and statistical purposes so long as
same does not identify my person or provide facts which could
lead to my identification. Any other information obtained,
however, will be used only by the program staff to evaluate my
exercise status or needs. 5. INQUIRIES AND FREEDOM OF CONSENT
I have been given an opportunity to ask questions as to the
procedures.

6. WAIVER AND RELEASE
I am aware that any activity prescribed at IRON WILL FITNESS
CLUB LLC, can pose the risk of serious illness, injury, and death,
and that participation exposes myself to that risk. I affirm that I am
medically qualified to participate and I will follow the instructor's
instructions regarding techniques, training, and all other rules. I
further agree to release, indemnify and hold harmless Iron Will
Fitness Club LLC, Caren Buchwalter, her employees,
representatives and/or agents from any and all liability for any and
all claims, demands, damages, costs, causes of action and
expenses, including, but not limited to, reasonable attorney fees
arising from my participation in any activities inside the gym,
outside the gym, public beaches, public parks, or any other
location. This release also allows the studio, Iron Will Fitness Club
LLC, to use my likeness for various reasons including for use in
local newspapers, marketing, advertising, and on our website as
well as social media forums such as, but not limited to: Facebook,
Twitter, Instagram, and Tumblr. This release and assumption of
risk run to my successors, assigns, heirs, administrators, executors,
and any and all members of my family.
I have read this Informed Consent Form, and fully understand it.